EMBARGOED UNTIL 10:30 a.m. (EST)June 17, 1996 CONTACT: Sara Foer [202/651-7023]; Martin DiCarlantonio--AJN (212)582-8820 x 411 AJN Survey Uncovers Critical Concerns among Registered Nurses about Patient CareWASHINGTON, DC -- June 17, 1996 -- Registered nurses (RNs) are feeling the pressures of nursing staff cutbacks in hospitals and increased use of unlicensed assistive personnel (UAP), warns an American Journal of Nursing (AJN) survey released in Washington today at a joint press conference with the American Nurses Association (ANA). Almost 9 out of 10 nurses polled indicated serious concerns that the safety and quality of patient care is being diminished by those same cost-saving practices. Over two-thirds of RNs polled indicated that they have seen an increase in the numbers of patients assigned to them, and three quarters of them say patient acuity has increased as well, which means that hospitalized patients are sicker and require more attention from nurses. Over half of the nurses noted a marked decrease in the length of stay and a marked increase in the number of unexpected readmissions. Over 60% of respondents reported an increase in the cross-training of RNs and reductions in the number of RN staff. According to Judith Shindul-Rothschild, PhD, RN, CS, assistant professor at Boston College who conducted the survey for AJN, all these factors have contributed to a labor trend known as speed-up.' This means that nurses are expected to work harder and faster with fewer resources, providing care for greater numbers of sicker patients in the same amount of time. Such a pattern invariably leads to higher turnover and an increase in work-related injuries, and ultimately jeopardizes quality of care, according to Shindul-Rothschild. Indeed, almost three quarters of nurses reported having less time to teach patients and families, comfort and talk to patients, document nursing care, and consult with the health care team. The number of patient complaints has also increased, according to more than half of the nurses who responded to the study. On average, almost 2 out of 5 nurses reported an increase in patient complications, medication errors, nosocomial infections, skin breakdown, and injuries to patients. One of the most telling statistics is that 37% of RNs would not recommend that a family member receive care in their hospitals, and while almost 15% would rate the quality of care at their facilities as poor or very poor, only 10% would rate the care as excellent. "This survey provides valuable insights into the perceptions of nurses about their work environments and the impact of cost-saving decisions on patient care and the nursing profession, from the point of view of the health professionals most personally involved with the patient," says ANA President Virginia Trotter Betts, JD, MSN, RN. Eighty-seven percent of the survey respondents believe that the use of UAPs does not improve the quality of care. Unlicensed health care workers, often called nurses' aides, nursing assistants, or patient care technicians, usually have about 40 hours or less of hospital-based training. Whereas the duration and content of training for unlicensed health care workers are determined by the hospital that employs them and varies widely, registered nurses must have between two and four years of higher education and must be licensed by the state in order to practice. The responses of nurses in the AJN study echo findings from two earlier ANA studies, one polling consumers in 1996 and another of nurses in 1994. In the 1996 consumer survey, Nursing and the Quality of Patient Care,' Americans indicated that they are worried about many of the changes in our health care delivery system and how they affect the quality of patient care in health care institutions. As many as three-quarters of the adults polled indicated serious concern that the quality of patient care is being diminished by some cost-cutting practices -- a concern that has increased significantly since 1994. Seventy-five percent of the survey respondents believed that reducing the number of registered nurses who provide bedside patient care in hospitals lowers the quality of care, and 67% said that increasing the use of unlicensed health care workers for care traditionally performed by RNs has the same quality-diminishing effect. In the 1994 ANA Layoffs Survey, registered nurses indicated that reducing RN staffs in hospitals was causing unsafe conditions for some patients and massive increases in the workloads of the remaining RNs. Two factors, apparently working in tandem, were identified by the nurses as having the primary influences in the deterioration of safety and quality of care--increased number of patients assigned to RNs, and less time to provide patient care. One effort to make hospitals accountable for their staffing actions is already underway. On April 30, 1996, Rep. Maurice Hinchey (D-NY) introduced "The Patient Safety Act of 1996," H.R. 3355, to make hospital data accessible to the public. This bill, the first of its kind and developed with ANA's support, mandates public disclosure by hospitals of staffing levels and outcomes and calls for "whistle blower" protections for nurses who speak out on behalf of patient care issues. As AJN and ANA jointly released the preliminary survey results at a press conference today during ANA's Convention and Centennial Celebration in Washington, they underscored the need for increased scrutiny of hospitals and other health care organizations that implement cost-cutting methods which undermine quality patient care. "The sample used in this survey is expected to reach over 10,000 nurses nationwide," said Lucille Joel, ANA immediate past president and AJN Editor-At-Large. "Nurses at the bedside are in the best position to shed light on how cost-saving decisions, like reducing the number of RNs, can negatively impact patients, as well as nurses." The 1996 AJN Patient Care Survey was conducted by Shindul-Rothschild and commissioned by AJN, whose staff reviewed the survey questions along with ANA. The preliminary findings which were released today are based on the responses of 5,000 RNs, whose average age is 43 years, the same as the national average for RNs. The survey population is representative of the demographics of the RN population nationwide in every category. Most of the respondents practice in hospital settings and have medical/surgical specialties, which is reflective of RNs nationwide. The survey was conducted from March through June 1996 and was designed to investigate nurses' perceptions of the safety and quality of patient care that is currently being delivered. According to Shindul-Rothschild, the AJN study is the first to identify the speed-up trend in nursing. The margin of error for the preliminary findings is less than 2%. The final report, to be published in the October AJN issue, will be based on the data of close to 10,000 registered nurses, and the margin of error will drop to less than 1%. Reporters may request a free copy of the AJN survey and preliminary results article (available July 1) by calling Martin DiCarlantonio,AJN Editorial Director, at 212-582-8820, ext. 411. Others may order reprints by calling 212-582-8820, ext. 203. ANA surveys are free to the press, $10 for SNA members, and $20 for nonmembers. ANA is the only full-service professional organization representing the nation's 2.2. million registered nurses through its 53 constituent associations. ANA advances the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the work place, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public. ANA's internet site, Nursing World, can be located at http://www.nursingworld.org. AJN, the professional journal of the ANA, is a peer-reviewed journal. The views expressed in AJN are solely those of the authors or persons quoted. They do not necessarily reflect AJN'S views. AJN'S internet site can be reached at http://www.nursingworld.org/ajn.
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